Healthcare Provider Details

I. General information

NPI: 1902177702
Provider Name (Legal Business Name): MOSES CONE AFFILIATED PHYSICIANS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2012
Last Update Date: 01/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E NORTHWOOD ST
GREENSBORO NC
27401-1310
US

IV. Provider business mailing address

1200 N ELM ST CONE HEALTH, ADMINISTRATIVE SERVICE, STE 201
GREENSBORO NC
27401-1004
US

V. Phone/Fax

Practice location:
  • Phone: 336-230-2434
  • Fax: 336-230-1540
Mailing address:
  • Phone: 336-832-8005
  • Fax: 336-832-8272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207YS0012X
TaxonomySleep Medicine (Otolaryngology) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. KENNETH K. BOGGS
Title or Position: CFO/TREASURER
Credential:
Phone: 336-832-8005